SPECIAL: Beyond Baggy Blues

Written By Daniella Barreto

How to stop COVID in hospitals

2025 holiday special!

If you go into hospital, you shouldn’t have to worry about getting more sick. Many people get COVID and other airborne infections from being in hospital, even though it’s preventable. This is a policy failure. And it's fixable.

Dr. Dick Zoutman, Board Chair of the Canadian COVID Society and professor emeritus at Queen’s University, shows us 5 ways to stop COVID (and more!) from running rampant at hospitals:

1. Surveillance

2. Masks/PPE

3. Cleaning the air

4. Vaccination

5. Education

RESOURCES

CREDITS

Public Health is Dead is created, produced, written & hosted by Daniella Barreto
Music, mixing, and sound design by Alexandria Maillot
Fact checking on this episode by Roanne G.

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  • DANIELLA: If I could gift-wrap this episode the card would read: 
    To: Health authorities and health ministers– here’s some top notch free help! Feel free to take notes. And implement ASAP. Xoxo Public Health is Dead.

    DANIELLA: If you have to go to hospital, the last thing you want is to get more sick. As winter approaches, COVID cases usually go up. Classically fall and winter is flu season. And we’re in an absolutely raging flu situation right now. 

    Canada is experiencing a healthcare crisis with Emergency Departments closing, I had not heard of that happening before the last few years. People experience long and sometimes life-threatening waits to see a doctor. A children’s hospital in Quebec recently said its emergency department is full because of influenza. 

    Healthcare workers come to work sick with COVID (and expose other workers and patients) - there’s some recent research published about this that it’s increased over time – probably for a host of reasons including fewer available staff… and there are fewer staff because they’re burnt out, sick, and many probably have Long COVID… So the cycle continues.  
    But it doesn’t have to be this way!

    DANIELLA: Hi Public Health is Dead listeners, I’m your host Daniella and this is a special episode with Dr. Dick Zoutman, professor emeritus at Queens University, one of Canada’s well-known infection prevention physicians and Board member of the Canadian COVID Society. This conversation was recorded earlier this year in 2025. 

    We’re releasing it now as we head into the holidays and winter and the COVID increase that typically comes with it. This is not a regular format episode and at points you may hear our guest’s parrot, Cosmo, chirping in with some opinions. 

    In this episode, Dr. Zoutman is going to share 5 suggestions to help stop rampant COVID transmission so hospitals are not just reacting when there’s a problem but preventing the harm in the first place. 

    This is a fundamental element to public health that has somehow been forgotten. 

    An ounce of prevention is worth a pound of cure? A stitch in time saves 9? Nip it in the bud? Safety first? I’m sure there are 10 more ways to say this because it’s just common sense to avoid and address a problem before you have a bigger problem or a crisis.

    Dr. Zoutman was heavily involved in finally putting a lid on the SARS outbreak in Toronto (the story of that outbreak and what public health should have learned from it is covered in Episode 4). Right after that happened, a paper he had written came out…

    ZOUTMAN:  …it hit a nerve. Um, I've never had a paper where I had so much commentary back and, and interest in the media and in the public, uh, ever in my career.

    It was about resources for infection control in hospitals. And what we discovered was that what was going on in hospitals was grossly inadequate to control the major issues in those days. We were seeing lots of staphylococcal infections, MRSA, methicillin resistant staph aureus and all the other so-called, you know, the media likes to call superbugs. That paper, you know, highlighted that there was so much more we needed to be doing and weren't doing.

    DANIELLA: Infection control has come a long way from 2003. There are all kinds of standards and best practices now. Have things changed?

    ZOUTMAN:  You know, I think things are different. I think there are more resources, there are more people involved.

    There are more infection control people in the hospitals. So you would think ostensibly that it'd be better. There’s more organizational support…  I will say with pain in my heart that the response of infection control that I know and love dearly has been, um, inadequate in my opinion, uh, regarding COVID. And that doesn't have to be. And uh, that's the part that really I find very upsetting because there's just so much we can do if we choose to, but we're choosing not to as far as I can tell.

    DANIELLA: People are worried about going to hospital for one thing and ending up with COVID or the flu.

    ZOUTMAN:  It shouldn't be this way. Um, and COVID is not a rare complication of being in, in, in hospitals. Uh, it's quite common. And, uh, it has all kinds of consequences. 

    ZOUTMAN:  Well, you know, we've been using respirators for quite some time in healthcare, you know, uh, because of, uh, tuberculosis in particular, which we know and acknowledge is airborne. That research goes back into the 1960s. Uh, similarly for things like measles that we know were airborne. So for as long as I've been in hospitals –over 40 years– there's been respirators, we didn't call them that – we sometimes called them TB masks or duck bill masks, because that was the style of the day.

    DANIELLA: Technology has gotten better, there are specific standards for their use and production and fit testing - quantitatively or qualitatively testing whether the respirator fits well enough to block airborne particles

    ZOUTMAN:  I think the healthcare workers should know that N95s are respiratory protection, whereas a surgical mask, which we all call “baggy blues”, um, are not. They are not a form of respiratory protection. They're very baggy, they're very loose fitting. They do not protect you against airborne respiratory pathogens significantly. You know, the estimates are 20, maybe 30% protection if you compare them to an N95, that gives you 95% protection or better.  Um, so there’s just no comparison.

    DANIELLA: N95s offer 95% or better filtration of particles (including airborne aerosol that can contain pathogens). This is one thing I find many people still don’t really understand. Pathogens like COVID, influenza, tuberculosis, and measles don’t just zip around naked in the air by themselves. They travel inside aerosols – particles which are produced when we exhale. So when we breathe, talk, sing, laugh, generally anything that forces air to rush over the wet surfaces of our airways will produce tiny aerosol. If they contain pathogens, that can make other people sick through airborne transmission. That is, inhaling aerosol that contains a pathogen – enough of it – to establish an infection. 

    Droplet spread can also happen but, especially with COVID and influenza, more and more research points to airborne transmission being the primary mode of transmission.

    One day we will do an episode on how exactly respirators work because the physics is just so cool. We have access to such fantastic and effective technology and most public health guidance glosses over or leaves it out. 

    ZOUTMAN:  the standards for using N95s as part of a respiratory protection plan for things like tuberculosis, but also now measles flu, COVID, SARS, includes fit testing and the various standards that are written are explicit. And so, you know, you can't avoid it. Um, it is a cost, uh, to the system, but it assures that the respirator is fitting properly, is going to do what you need it to do. Um 'cause it is possible that someone who's gonna be highly exposed may be wearing a respirator that is wrong for them. And so, being fit tested in healthcare with, uh, ideally quantitative fit testing, is the right way to go.

    Now in the community, that's hard to do. There's so many more people in the community than there are working in a hospital. So, uh, it's not practical to fit test people. Um, so we have tried to show people how to fit check, you know, which is kind of a poor person's way of checking to make sure your respirator is fitting. But still, even an unfitted  respirator is offering you far superior protection than any surgical mask (or balaclava or scarf or whatever else you might use, cotton mask, whatever) provide.

    DANIELLA:  It's so silly to me. I've been into a hospital wearing a respirator and been told to change into a surgical. It just blows my mind that these could be compared even if mine isn't fit tested. 

    ZOUTMAN: Oh, I know. I’ve had the same experience walking into a hospital where I used to work and, and you know, I would look at people and they generally recognize me, you know, when I, now that I'm not working there and I was, you know, going to a clinic appointment myself, uh, you know, nudge, nudge, wink, wink. No, I'm not taking it off. I'll put your baggy blue over top. Like, which is what people kind of acquiesce to, uh, without causing, you know, arguments at the front door of a hospital

    DANIELLA:  It was almost like hospitals and people working in them were more concerned with the theatre of infection prevention rather than actually preventing infections. 

    Some context on Canada–

    ZOUTMAN:  it's becoming more and more difficult to find out, well, what's the status of Covid in Canada? It's getting harder and harder, um, to get that kind of information. The wastewater testing in Ontario, for example, being cancelled, uh, was a very valuable resource in that regard.

    DANIELLA: Someone in BC who keeps close tabs on wastewater monitoring and COVID variants in it pointed out that in September 2025, the BCCDC quietly reduced the number of sampling sites from 12 to 8 and the frequency of testing from twice a week to once a week. So now we have less information, more slowly.

    ZOUTMAN: The official statistic is that there's been about, you know, 7 million official deaths officially, but the experts know, counting mortality you think would be easy to, actually, it's quite difficult. Uh, it's closer to 30 million, even as high as 36 million. 

    And that's, you know, a number close to the population of Canada. You know, 30 we're 40 million in Canada, so 30, 35 million people having died worldwide is a massive mortality.

    ZOUTMAN: The other statistic that leads into what's going on in hospitals is the Canadian Nosocomial Infection Surveillance Program, a program that's sponsored by Health Canada and the Public Health Agency of Canada that I helped get involved with when it started some over 20, 25 years ago.

    Of the people who are in hospital who have COVID as many as half got the COVID because they were in hospital. 

    DANIELLA: At the time of recording, approx 47% of all hospital cases of COVID had been acquired in hospital. Today it looks like it’s a bit lower on their data table but from the testing that still happens, and it doesn’t always happen, we’re still at about 1 in 3 COVID cases happening for people who did not have COVID before they went to hospital. We know from a lot of published research sources that there is significant transmission in hospitals between patients and healthcare workers and that hospital transmission drives community transmission.

    ZOUTMAN:  Now that’s a shocking amount of COVID that is acquired because you were in hospital and, and it, it's very frightening. People who get COVID in hospital have a much higher mortality in the range of 10%. And that's highly variable based on your health. You know, if you're very young and you're there because you've fractured your ankle, it's very different than if you're, you know, over 65 or over 70 or over 80 and have heart and lung problems. The risk is much higher. 

    ZOUTMAN : And then it's not just the patients though, it's also the staff. We've known for some decades that we were heading into  a shortage of nurses and doctors and radiology technologists and lab technologists and physiotherapists, and all the people that make a hospital work. And make healthcare work. There's a meta-analysis that was done out of, out of Yale that looks like one in three healthcare workers have Long COVID. And there was a similar, uh, study done out of the UK, where about one in three healthcare workers, 30% of healthcare workers have the symptoms of long COVID.  Just let that sink in. You know it’s a huge problem. In the UK with their inquiry that's going on they're discovering that a lot of healthcare workers not only have long COVID, but they don't know they have long COVID. And a lot are, you know, not able to continue to work. 

    And the implications to our healthcare system are drastic. Uh, we had a healthcare shortage that we knew was going to happen with the growth of the baby boomers, you know, in my age group needing care now and the and the generations behind them, being a smaller volume number of people was gonna be a problem anyway. However, you add, you know, implications of COVID, Long COVID on top of that, and we're in trouble.

    DANIELLA:  I guess we need to get more doctors, more nurses, more healthcare workers, but if we're not gonna protect them is that a useful strategy? I don't know. 

    ZOUTMAN: Yeah. Well, more, more, more food for the virus, you know, uh, sorry, a bit, uh, harsh. But you know what, Daniella, there are things, a lot of things that we can do in our healthcare setting – five things 'cause I like to count on the fingers in one hand.

    And, and they are: surveillance, looking for cases so that you know what's going on and we're not doing that. Cleaning the air. We'll talk a little bit about that. We've talked a little bit about masks and PPE, you know, personal protective equipment, vaccination, and information and education.

    DANIELLA: So again, public health leaders and health authorities, if you’re taking notes, which I hope you are, that’s: surveillance, cleaning the air, masks/PPE, vaccination, and this is one piece together– information and education

    ZOUTMAN:  And with those five things, those five layers, we can reduce the impact of COVID in our healthcare to a level that would be less than a minor nuisance. It wouldn't be eradicated by any means, but it would not be causing the massive problems that we are seeing. And most, almost all of these things are, most of these things are transferable to other settings like schools, colleges, universities and other settings and even restaurants and bars and theaters and what have you.

     Now something that we have struggled with is that COVID is airborne. And as we talk and breathe and cough and sneeze, sing and all of that, we spew out COVID viruses when, you know, if you've got COVID.

    ZOUTMAN: And, uh, the other sleeper fact about COVID besides being airborne, is that about 40% of cases are asymptomatic or have almost no symptoms. And that means people could go to work or get admitted to a hospital or work in a hospital and have COVID and not even know it.  

    DANIELLA: I went to a masks-required, air filters blasting holiday party recently where the hosts had everyone do a rapid test the day before and then provided a Pluslife test upon arrival. Pluslife tests are much more involved and they’re more accurate. Lo and behold, someone actually had COVID that was picked up on the Pluslife test but not the rapid test and they had no idea. They of course did the responsible thing and went home. But just goes to show - asymptomatic cases do happen and asymptomatic transmission has been clearly documented.This is why masking is so important to interrupt asymptomatic or pre-symptomatic spread. We can still pass infections on when we feel fine and don’t know we’re sick. Wearing masks only when we have symptoms or when we feel sick misses a huge part  of transmission.

    DANIELLA: Dr. Zoutman talked about a couple of papers on transmission with some interesting results that I’ll drop in the show notes if you’d like to have a look yourself. One was a Swedish study in Nature looking at a model about how quickly patients would receive an infectious dose of SARS-CoV-2 via indoor air transmission. 

    ZOUTMAN:... if an infected individual, who has COVID, who's expelling COVID, enters a room and then there's a susceptible person going into that room, they can inhale the dose within six minutes.  Um, just being in that room. And within six to 37 minutes they worked it out. So that's very fast. And, um, you think of a nurse coming into a patient's room and that patient may have COVID or the nurse could have COVID and they're gonna spend more than six minutes together. And, uh, that either the patient's gonna get COVID from the nurse or the nurse is gonna get it from the patient, or, you know, or the patients if they're sharing a room… So we've got a lot of COVID being transmitted in our hospitals. And we don't even know anything about it 'cause we're not looking for it. 

    ZOUTMAN:  And one of the challenges I think with the testing was the very unfortunate fact that we had to stick, put a stick up your nose, you know? I mean, let's face it, it's not nice. Um, and we've all had it. I can't imagine there’s many people listening who haven't had at least one of those nasopharyngeal swab things go on, you know, up your, up your nose and it's not pleasant. Um, and it, we don't have to do that anymore. 
    We can now test saliva. The nasopharyngeal swab is still the best way,  But for the point of view of surveillance, trying to find out of all the people that are coming into a hospital, the thousands of people that work in a hospital every day, they don't wanna come into work and have nasal pharyngeal swabs done.

    I mean it, and it would slow up people, you know, getting into the hospital. It would just be not doable. But saliva is doable and you can run tests on saliva. So all you have to do is have people submit a small saliva sample and little little tube with a little lid on it, with their name on it. Um, and, uh, the, that can, that is highly effective, uh, to, uh, identify, uh, COVID by PCR testing.

    And the other thing that you can do is pool the tests so you can Take the saliva samples and take say 10 of them and pull them into one. Just pour 'em all together and run that through PCR Technique. Lab work's a little messy, sometimes

    ZOUTMAN: When you  work in a lab, you get used to that kind of thing. But if you pull the samples that just say you put put 10 together and you run them and they're all negative, then that whole group of 10 people, you know, are negative, you don't have to go any further. If one of them is positive, the whole sample will come up positive. So then you've gotta go back and test all the 10 people who were part of that pool. And there are computer systems that organize all of that and keep track of the automated systems now. And that allows you to be more efficient and quick about getting the testing done 'cause if a whole bunch of them are negative… if you do the testing, uh, and you find somebody who's positive, you go back and test, then you know, okay, this person is positive. Whether they were a patient being admitted or they were a staff member. And you can say, for example, to the staff member, “Hey, you know, you need to come down to occupational health and we need to talk to you 'cause your sample came up positive” and they can, uh, send you home and follow up on you uh not gonna be working, passing it on. 

    And also that information would be incredibly helpful, wouldn't it? Because if you had three staff members on one unit on the west wing of your hospital, all positive, you know something's going on in that part of your clinic and you can actually do something.

     ZOUTMAN: There's now, and also, you know, new technology lab-on-a-chip technology that you don't even have to do chemical extraction to pull the RNA out. I mean, it's much faster and they're sensitive for now, not only COVID, but for influenza A and B down to, you know, 50 viruses per milliliter. Very, very sensitive technology.

    And these are things that hospitals could implement so that they would be able to test patients, test staff in particular, um, in the least invasive way that, you know, a little spitting into a tube is not that big a deal um, and I think that is something that hospitals can do and then use that information to inform them, you know, what's going on and what are the strains and what are the variants that are coming on. 

    And if hospitals did that in a coordinated way across, you know, the province, across the country, that information would be very valuable. At a very practical but also at a national level.

     ZOUTMAN:  When hospitals say, now we're putting back mask mandates, you know, makes me kind of smile in a, in a sarcastic kind of way, because first they're putting on “baggy blues”, which we've already talked about, you know, aren't gonna do much. And they're also doing it when the horse is out of the barn, the COVID is already spreading heavily throughout the organization. And the number of outbreaks we have in hospitals is, is astounding. 

    The other technique that's really interesting, we all know about wastewater testing– community. And that's been something that we had the ability to do and we're, we're doing at a low level prior to COVID. Now we're doing it at a, at a huge level, although Ontario unfortunately has canceled the provincial program except for a few sites.

    But, um, what I think is fascinating is that researchers have shown that you can do wastewater testing in a facility like a hospital or a big clinic or a school or a university 'cause you know, the person who knows the anatomy of the plumbing, you know, where all the toilets go kind of thing, um, can tell you which, which are the main pipes.

    So this main pipe is for the west wing and this main pipe is for the North Wing and the South Wing. All that. And, um. There's a great paper from the University of Alberta, uh, in cooperation with the National Micro Lab in Winnipeg, in Lancet Microbe and they looked at wastewater testing in, in facilities and you can test the water going out of your building and determine, wait a minute, there's a positive signal on the East wing. But not the other wing. So there's a problem. And, and just like we talked before, that's an early warning, and that's in real time. “oops, folks, we have a problem.” And it allows you to intervene immediately.

    And the other technique for looking for the virus, which has really got me excited with the technology has just really blows you away is actually just sampling the air.

     We are now at a stage, Daniella, that we have devices and there's several, uh, one of the better known ones is the aerosol sense device.  Um, looks like a microwave oven with a little pipe sticking out of the top, and it sucks the air out of the room. And, uh, that air ends up on a membrane that is tested for the viruses and is incredibly sensitive.

    The other thing you can do, and this is really cool, is you can connect these devices to the air ducts. So think of the return air ducts, you know, the air that gets blown in the room from the air HVAC system, but it has to go out. And  you think of the air duct where the air returns back into the system and you put, you can link these devices into the air duct and, uh, detect in real time the viral load actually in the air. And this is a very powerful tool 'cause you can get real time results that are very sensitive and they're gonna get better because the engineers just keep working and working and working on this. And, um, I think with, you know, testing the water, testing people with saliva and pooled specimens, and then testing the air, uh, there's no excuse now for not knowing what's going on in your own facility.

    DANIELLA: You've mentioned wearable sensors. What's that about?

    ZOUTMAN: I am a bit of a techno geek, as you can tell.  That one's from Yale, and it was published in Environmental Science Technology Letters in January ‘22 so I'm sure they've done more work and more advances on it. Basically, it's a little clip that you just wear on your collar or on your lapel of your lab coat or your blouse, or your shirt, whatever you're wearing.

    It's based on a polymer called polydimethylsiloxane, which is just a material that, and, Yale University. Uh, developed it and they, so they made it into the shape of the letter Y of course, for the university, which makes sense. Um, and the viruses glom onto this, and then the clip can be sent off to the lab and be tested.

    There's no batteries, there's no electronics.  And, um, it can detect COVID with great sensitivity when they do PCR and extract the RNA, uh, from this polymer. And, uh, it's kind of like what people who work in the X-ray department of a hospital, they have to wear those little brown things that are X-ray dosimeters that measure how much radiation they've been exposed to in their work.

     This kind of does the same sort of thing, and you could at the end of your day, drop it into a box and it could be tested overnight and you'd know exactly uh-oh, you know, there's something going on in this part of the hospital where the samplers are becoming, and then you don't have to do the, the wearer doesn't have to do anything

     A lot better than a stick up your nose!

    ZOUTMAN:  All the things we've talked about so far about how to detect it, um, but how do you just get rid of it, you know? I mean, how are we able to do that? And we now know so much more about air cleaning than we did prior. The amount of research that's been done is spectacular. And now I'm reading journals, you know about, uh, air system engineering that I never would've before. It's a fascinating area. And, and, uh, so beside measuring the, the, the quality of the air, we now have of course the, the, the, the ASHRAE standard, the American Society for Heating, Refrigeration Engineers. And it's an international standard 241 that where these folks put their heads together and say, okay, what are we gonna do to prevent transmission of infectious diseases?

    The basic  concept is the more air flow there is in a room, the more air that's pumped into the room and it's pumped out of the room, the less likely a virus is going to get you because it's being flushed out of the room. Like it's not a hard concept to understand. 

    ZOUTMAN: Now  if you're an engineer, it's more complicated than that because air in the room goes up. You know, our bodies are like little thermoses and we generate heat, and there's a plume of air coming up from your body. You can imagine a plume of air going up from your body over your head into the ceiling and coming back down again, and all this kind of stuff going on. 

    But they've learned that if you can get air changes per hour, we've talked about, you know, how many air changes per hour. I mean, your air changes in your home are likely one or two. Uh, you know, unless you've done an awful lot to your HVAC system in your home. Um, but you know, we've talked about at least five air changes per hour, which is the whole air in the room is switched over five times or six times in an hour.

    That seems to be where you start to see real benefits. Um, but they've looked at the benefits and have actually talked about in, you know, what about a waiting room in a doctor's office or a dentist's office? This usually jammed to the rafters. They're recommending 30 air changes per hour. That's a lot, that's what we do in operating rooms now.

    So that means that we have to crank up the fans and, and really, you know, make sure that the duct work will handle that. Um, and they, they, they also measure it in litres per second, per person, because the more people in the room, the greater the risk, right? If you have one person in a gigantic room, the risk is not very high. If you got, you know, 200 people, it's a different kind of risk.  

    So they're recommending, you know, 30 air changes per hour. They're, you know, in a waiting room, in a patient room, uh, you know, about 9 air changes per hour, which is very doable in a treatment room and so forth. So we now have a standard to work against. And people know now that if you measure the carbon dioxide level, which is what we all exhale, is a waste gas from our bodies, and normally carbon dioxide out on, you know, outside is in what the 350 range or what have you, um, indoors, you want to get it be less than a thousand and they're saying let's keep it in the 5-600 range.

    If you do that, you're going to see a reduction in transmission that is pushing 80 plus percent.  

    A study in Italy looked at ventilation of 10 liters per second per person, which was in the range of what I said for a healthcare patient room. And if you get to that level, the reduction in transmission of covid is 80% reduction. Right there. Boom. Done

    ZOUTMAN:  So it depends on the risk of how many people are in the room, but, um,  their study was in a, in a school. But you can get, you know, restaurants can be more crowded, for example. But if, if just five to six air changes per hour can get you 80% reduction,  uh, why are we not doing that?

    I mean, uh, now some hospitals don't have air ventilation systems. They have passive air movement. The only way you're gonna get air movement in some wings of some older hospitals is by flapping your arms, right? Or like opening the windows, which you're going to be reluctant to do in January in Ontario, or Manitoba or, or Quebec!

    And so then you're stuck, you know, what do we do? You know, but there's another solution to that. The room air purifiers that we've all probably seen, you know, they started off as Corsi Rosenthal boxes after Dr. Corsi and Rosenthal are designed, but the room air purifier, that which there are many, uh, out there, um, you can also get them at a kind of industrial scale, scaled up real big ones.

    They look the size of a refrigerator, a, a smaller refrigerator, but as tall as a fridge, but not as wide. And they, instead of getting 300 cubic feet per per minute clean air delivery rate, which is what you're, the one you'd buy at a local hardware store will get you for your, for your living room. These ones deliver 3-, 4-, 5,000.

    ZOUTMAN:  Addenbrooke Hospital in Cambridge in the UK have done a beautiful study that they published in October, 2021
    DANIELLA: They found SARS-CoV-2 in the air,

    ZOUTMAN:  they turned the fans on the, the air cleaners on it went away. And then the  COVID came back when they turned the units off again. They published this, this paper in Clinical Infectious Diseases. So we know these devices work. In older hospitals, um, if you don't have mechanical air ventilation systems, you can put in these air, these large air purifiers, industrial size, and they can accomplish a great deal and you can achieve very good, um, air cleaning effects.

    There's always, there's a solution to these, these challenges you know with the newer technologies that we have, and some of them are older technologies.

     ZOUTMAN: The other thing that is an old technology, you know, Daniella, that's over 70 years old are germicidal, ultraviolet, right. Um, these lights operate at a wavelength of 2 54 nanometers. If they're properly shielded and high enough in the ceiling, at least seven or eight feet up in the, on the ceiling, they will shine ultraviolet light  along the ceiling and that, and the, and the heads and the airspace just underneath the ceiling. And so the top 20% of the room or so is going to have an intense amount of UV radiation.  It's out of the line of sight for us. Unless you're eight feet tall, um, you're not going to have any issues. 

    And this technology's been around, you know, for 70 years and we've been using it in TB hospitals for that long, and we know that it works. And yet the deployment has been negligible in, in, in healthcare that I've seen.

    There's a great study in a big Chinese dental clinic in the Journal of Hazardous Materials and they looked at the relationship between the air ventilation we've been talking about and adding in ultraviolet light. You have to kind of get the right mix. You know, it's kind of like adding the right amount of salt and pepper to something so it tastes right.

    DANIELLA:  If the air changes were too high, it kind of diluted out the effect of the UV radiation. And so there’s a balance to strike

    ZOUTMAN:  But they were able to achieve optimal performance again with the right amount of ventilation, over 80% reduction in COVID virus, in their dental clinic, uh, ultraviolet light, which is very cheap. Not quite plug and play but pretty much - you need an engineer and electrician. You put them in. They’re not profoundly expensive. You balance it with the right number of air changes so you get the right mix. And they had a tremendous amount of effectiveness in reducing the amount of lice virus in their dental clinics.  And these UV lights can also be installed inside the ducts.

     There's a great paper from the mechanical engineering department at the University of Alberta in Edmonton,  and, uh, they studied, uh, in, in, in the journal building in environment, um, in back in 2021, they reviewed 25 different kind of UV light systems that can go into duct work. And a hundred percent reduction in viruses is typical with this technology, again, has to be designed for your system by an engineer because there's all kinds of issues you have to deal with.

    Given what the patients suffer, the mortality, it's it's actually urgent that we do this. And this is not, you know, we don't invent anything new. We can take what we have and get the engineers going and, uh, put in the filters, put in the UV lights, do the sampling and the testing, you know, in the wastewater, in the duct work and maybe collect a little saliva now and again. And, uh, you know, these things can create an environment where people will be safe. 

    DANIELLA: Ok, now personal protective equipment – PPE.

    ZOUTMAN:  The Addenbrook hospital I mentioned in Cambridge before they published another paper, um,  November of 2021 on their use of, of uh, what they call an FFP3, which is uh N99 equivalent in the UK.

    When they changed to the FFP3 respirators, the risk of transmission of COVID during the acute phases of the early period of the pandemic of the pandemic were reduced, you know, approaching a hundred percent protection, uh, when they, you know, this is measured before and after, uh, when people were working on COVID inpatient units.

     And a really interesting study was done in Cologne, Germany, on their bone marrow transplant unit. These are the most vulnerable patients going, 'cause they've been given chemotherapy to wipe out their immune system while they get their bone marrow transplant and they wait for the bone marrow to kick in but there's a couple of weeks of waiting and they have a high rate of all kinds of infections, including viral respiratory infections. And what they did in Cologne, Germany is for various periods when COVID was most active, they made it mandatory for all staff to wear an N95 equivalent and visitors, and get this, the patients. Now the patients had to wear it when they left their room. When they were in their room, they didn't have to wear the N95. But when they left their room to go down the hall or just wander around do a little exercise or went off for an X-ray, they wore N95. And their viral respiratory infection rates, including flu, COVID, all of the viruses dropped by 90%.  That's it. So it, you know, that's incredible. And these are the most vulnerable patients you will identify.

    DANIELLA:  It's possible. Listen to Dr. Zoutman’s conversation with the World Health Network, about Canada’s fight to require respirators in hospitals. I will link it in the show notes as well.

    DANIELLA: And of course, vaccination–

    ZOUTMAN:  One of the, one of the hot topics was, you know, was the mandatory vaccination of, of healthcare. It didn't, uh, go over well with some people, but it was necessary at the time, and it, you know, in my opinion, it still is necessary. We know that the vaccine, you know, doesn't protect fabulously against getting COVID, although the protection factor can be, you know, as high as 50% in the first few months after you get your vaccine. So that's important.

    DANIELLA: Dr. Zoutman pointed out that a recent meta analysis – for those less familiar, that’s answering a research question by looking at a bunch of studies that have already been done and pooling the results to see what all of them say when taken as a whole. So he pointed out that there was a meta analysis that showed an association between COVID vaccination and lower risk for Long COVID. Estimates vary but a reduction in Long COVID is consistent with multiple studies of this kind. 

    ZOUTMAN:  Given what long COVID does to you, you don't want Long COVID  the vaccine, it just adds to the layers of protection, uh, for everybody, um, including healthcare staff. And why I still believe it's a good idea to for all healthcare staff to be vaccinated.

    DANIELLA: And last, education. The whole purpose of this show.

    ZOUTMAN:  I've been working with the Canadian COVID Society recently, uh, and I put a shameless plug in for Canadian COVID Society, who are a bunch of us working on making COVID uh, awareness, uh, improved, that people can learn about COVID. Daniella, thank you for, you know, doing this podcast. I think it's a very important public service and, uh, um, speaking with other, my other colleagues from the Canadian COVID Society who are working very, very hard, you know, to educate Canadians and  see, make the changes necessary. And there are many, many people in various organizations across the country, innumerable, likely, working away on this. And so I think this public service and education of the public is, is absolutely critical.   

    DANIELLA: If people don’t know what public health isn’t clearly telling them, then how do we possibly expect to get out of this? 

    Well there you have it folks, 5 suggestions for your hospital that will help stop the spread of COVID and likely have an impact on how much is spreading in the community too. 

    And, bonus tip: some of these interventions would also work with keeping a handle on influenza. And measles. And tuberculosis. You get the picture. 

    Public health leaders, respirator is not a bad word. Use it. Use them. And we could clean the air while we’re at it.

    If you live in British Columbia, or even if you don’t, you can help an organization called Do No Harm BC by signing their petition to bring back masks in healthcare. 

    Going to hospital shouldn’t mean risking getting more sick or dying from something that’s preventable. I have linked the petition in the shownotes. 

    CREDITS
    Public Health is Dead is created, produced, written, edited and hosted by Daniella Barreto. Music, mixing, and sound design by Alexandria Maillot. Fact checking support from Roanne G. for this episode. Thank you all so much and thank you to everybody who has supported the show over the year. We have a lot of plans for Public Health is Dead in 2026 and if you’d like to support that happening because it’s not cheap and it’s not easy. Please chip in to help produce more of the show you love. 

Daniella Barreto
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